<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_id" data-rule="required" data-source="user/user/index" data-field="nickname" class="form-control selectpage" name="row[user_id]" type="text" value="{$row.user_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address_id" data-rule="required" data-source="address/index" class="form-control selectpage" name="row[address_id]" type="text" value="{$row.address_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_sn')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_sn" data-rule="required" class="form-control" name="row[order_sn]" type="text" value="{$row.order_sn|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_status" data-rule="required" class="form-control" name="row[order_status]" type="number" value="{$row.order_status|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Aftersale_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-aftersale_status" data-rule="required" class="form-control" name="row[aftersale_status]" type="number" value="{$row.aftersale_status|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Consignee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-consignee" data-rule="required" class="form-control" name="row[consignee]" type="text" value="{$row.consignee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-mobile" data-rule="required" class="form-control" name="row[mobile]" type="text" value="{$row.mobile|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-address" data-rule="required" class="form-control" name="row[address]" type="text" value="{$row.address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Message')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-message" data-rule="required" class="form-control" name="row[message]" type="text" value="{$row.message|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Goods_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-goods_price" data-rule="required" class="form-control" step="0.01" name="row[goods_price]" type="number" value="{$row.goods_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Freight_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-freight_price" class="form-control" step="0.01" name="row[freight_price]" type="number" value="{$row.freight_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Coupon_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-coupon_price" data-rule="required" class="form-control" step="0.01" name="row[coupon_price]" type="number" value="{$row.coupon_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_price" data-rule="required" class="form-control" step="0.01" name="row[order_price]" type="number" value="{$row.order_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Actual_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-actual_price" data-rule="required" class="form-control" step="0.01" name="row[actual_price]" type="number" value="{$row.actual_price|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_id" data-rule="required" data-source="pay/index" class="form-control selectpage" name="row[pay_id]" type="text" value="{$row.pay_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pay_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pay_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[pay_time]" type="text" value="{$row.pay_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ship_sn')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ship_sn" class="form-control" name="row[ship_sn]" type="text" value="{$row.ship_sn|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ship_channel')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ship_channel" class="form-control" name="row[ship_channel]" type="text" value="{$row.ship_channel|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Ship_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-ship_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[ship_time]" type="text" value="{$row.ship_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refund_apply_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refund_apply_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[refund_apply_time]" type="text" value="{$row.refund_apply_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('After_sales_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-after_sales_type" class="form-control" name="row[after_sales_type]" type="text" value="{$row.after_sales_type|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refund_amount')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refund_amount" class="form-control" name="row[refund_amount]" type="number" value="{$row.refund_amount|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refund_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refund_type" class="form-control" name="row[refund_type]" type="text" value="{$row.refund_type|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refund_content')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refund_content" class="form-control" name="row[refund_content]" type="text" value="{$row.refund_content|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Describe_credentials')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-describe_credentials" class="form-control " rows="5" name="row[describe_credentials]" cols="50">{$row.describe_credentials|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refund_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-refund_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[refund_time]" type="text" value="{$row.refund_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lock_version')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lock_version" class="form-control" name="row[lock_version]" type="text" value="{$row.lock_version|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Confirm_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-confirm_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[confirm_time]" type="text" value="{$row.confirm_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Comments')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-comments" class="form-control" name="row[comments]" type="number" value="{$row.comments|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('End_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-end_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[end_time]" type="text" value="{$row.end_time}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Store_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-store_id" data-rule="required" data-source="store/index" class="form-control selectpage" name="row[store_id]" type="text" value="{$row.store_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Product_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-product_type" class="form-control" name="row[product_type]" type="number" value="{$row.product_type|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lease_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lease_type" class="form-control" name="row[lease_type]" type="text" value="{$row.lease_type|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lease_term')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lease_term" class="form-control" name="row[lease_term]" type="text" value="{$row.lease_term|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('License_plate')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-license_plate" class="form-control" name="row[license_plate]" type="text" value="{$row.license_plate|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zstart_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zstart_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[zstart_time]" type="text" value="{:$row.zstart_time?datetime($row.zstart_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zend_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zend_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[zend_time]" type="text" value="{:$row.zend_time?datetime($row.zend_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_number" class="form-control" name="row[order_number]" type="number" value="{$row.order_number|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Estimated_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-estimated_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[estimated_time]" type="text" value="{:$row.estimated_time?datetime($row.estimated_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Specifications')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-specifications" class="form-control " rows="5" name="row[specifications]" cols="50">{$row.specifications|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Refusal_to_refund_text')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-refusal_to_refund_text" class="form-control " rows="5" name="row[refusal_to_refund_text]" cols="50">{$row.refusal_to_refund_text|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Delivery_code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-delivery_code" class="form-control" name="row[delivery_code]" type="text" value="{$row.delivery_code|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Return_code')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-return_code" class="form-control" name="row[return_code]" type="text" value="{$row.return_code|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Delivery_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-delivery_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[delivery_time]" type="text" value="{:$row.delivery_time?datetime($row.delivery_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Frame_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-frame_number" class="form-control" name="row[frame_number]" type="text" value="{$row.frame_number|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lease_city')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class='control-relative'><input id="c-lease_city" class="form-control" data-toggle="city-picker" name="row[lease_city]" type="text" value="{$row.lease_city|htmlentities}"></div>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lease_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lease_address" class="form-control" name="row[lease_address]" type="text" value="{$row.lease_address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Lease_mobile')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-lease_mobile" class="form-control" name="row[lease_mobile]" type="text" value="{$row.lease_mobile|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Deposit')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-deposit" class="form-control" step="0.01" name="row[deposit]" type="number" value="{$row.deposit|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Return_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-return_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[return_time]" type="text" value="{:$row.return_time?datetime($row.return_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('P_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-p_status" class="form-control" name="row[p_status]" type="number" value="{$row.p_status|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_door')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-is_door" class="form-control" name="row[is_door]" type="number" value="{$row.is_door|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Q_user_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-q_user_id" data-rule="required" data-source="q/user/index" class="form-control selectpage" name="row[q_user_id]" type="text" value="{$row.q_user_id|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pickup_note_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pickup_note_number" class="form-control" name="row[pickup_note_number]" type="text" value="{$row.pickup_note_number|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Deduction')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-deduction" class="form-control" step="0.01" name="row[deduction]" type="number" value="{$row.deduction|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Commission')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-commission" class="form-control" step="0.01" name="row[commission]" type="number" value="{$row.commission|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_overtime')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-is_overtime" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[is_overtime]" type="text" value="{:$row.is_overtime?datetime($row.is_overtime):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Is_deduction')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-is_deduction" class="form-control" name="row[is_deduction]" type="number" value="{$row.is_deduction|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Trailer_address')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-trailer_address" class="form-control" name="row[trailer_address]" type="text" value="{$row.trailer_address|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Store_name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-store_name" class="form-control" name="row[store_name]" type="text" value="{$row.store_name|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Trailer_longitude')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-trailer_longitude" class="form-control" name="row[trailer_longitude]" type="text" value="{$row.trailer_longitude|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Trailer_latitude')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-trailer_latitude" class="form-control" name="row[trailer_latitude]" type="text" value="{$row.trailer_latitude|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_location')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_location" class="form-control" name="row[user_location]" type="text" value="{$row.user_location|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_longitude')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_longitude" class="form-control" name="row[user_longitude]" type="text" value="{$row.user_longitude|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('User_latitude')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-user_latitude" class="form-control" name="row[user_latitude]" type="text" value="{$row.user_latitude|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Rider_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-rider_status" class="form-control" name="row[rider_status]" type="number" value="{$row.rider_status|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('On_site_photos')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-on_site_photos" class="form-control " rows="5" name="row[on_site_photos]" cols="50">{$row.on_site_photos|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Defective_vehicle_model')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-defective_vehicle_model" class="form-control" name="row[defective_vehicle_model]" type="text" value="{$row.defective_vehicle_model|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Order_acceptance_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-order_acceptance_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[order_acceptance_time]" type="text" value="{:$row.order_acceptance_time?datetime($row.order_acceptance_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Arrival_time_of_vehicle')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-arrival_time_of_vehicle" class="form-control" name="row[arrival_time_of_vehicle]" type="number" value="{$row.arrival_time_of_vehicle|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Arrival_time_at_destination')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-arrival_time_at_destination" class="form-control" name="row[arrival_time_at_destination]" type="number" value="{$row.arrival_time_at_destination|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Appeal_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-appeal_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[appeal_time]" type="text" value="{:$row.appeal_time?datetime($row.appeal_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Reason_for_appeal')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-reason_for_appeal" class="form-control" name="row[reason_for_appeal]" type="text" value="{$row.reason_for_appeal|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Statement_description')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-statement_description" class="form-control " rows="5" name="row[statement_description]" cols="50">{$row.statement_description|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Picture_of_appeal')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-picture_of_appeal" class="form-control " rows="5" name="row[picture_of_appeal]" cols="50">{$row.picture_of_appeal|htmlentities}</textarea>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Q_appeal_status')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-q_appeal_status" class="form-control" name="row[q_appeal_status]" type="number" value="{$row.q_appeal_status|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Installation_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-installation_fee" class="form-control" step="0.01" name="row[installation_fee]" type="number" value="{$row.installation_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Delivery_fee')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-delivery_fee" class="form-control" step="0.01" name="row[delivery_fee]" type="number" value="{$row.delivery_fee|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Pickup_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-pickup_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[pickup_time]" type="text" value="{:$row.pickup_time?datetime($row.pickup_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Deliveryd_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-deliveryd_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[deliveryd_time]" type="text" value="{:$row.deliveryd_time?datetime($row.deliveryd_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Service_completion_time')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-service_completion_time" class="form-control datetimepicker" data-date-format="YYYY-MM-DD HH:mm:ss" data-use-current="true" name="row[service_completion_time]" type="text" value="{:$row.service_completion_time?datetime($row.service_completion_time):''}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Unlock_type')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-unlock_type" class="form-control" name="row[unlock_type]" type="text" value="{$row.unlock_type|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
